Tibiotalar Dislocation Research Articles

Long-term Clinical and Radiographic Outcomes Following Surgical Treatment for Ankle Fracture-Dislocations: Do poor radiographic outcomes always matter?

Background Ankle fractures constitute 10% of all traumatic fractures in clinical practice. Concurrent tibiotalar dislocations form 21-36% of all ankle fractures. Although mechanism of injury is similar to non-dislocated ankle fractures, fracture-dislocations cause more extensive bone and soft tissue damage. Treatment is a challenge for orthopedic surgeons due to concomitant pathologies. It is associated with malreduction, chronic pain and most importantly, posttraumatic osteoarthritis. We aimed to investigate the relationship between ankle osteoarthritis radiographic stage and clinical outcomes. Methods 27 patients (17 female, 10 male) were included in the study. Records and data were retrospectively analyzed. Clinical status at the final follow-up was evaluated by a single orthopedic surgeon. Range of motion (ROM), American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score, visual analogue scale (VAS) were the clinical parameters that were assessed. Radiological assessment was made by standard anteroposterior [AP], lateral, and mortise views. Pre-operative osseo-ligamentous injury pattern, presence of posterior malleolar fracture, syndesmosis injury and post-operative ankle osteoarthritis were investigated. Results For 27 patients that were evaluated, at the final follow-up, mean AOFAS was 85 ± 8.12, and mean VAS during daily activities was 1.52 ± 0.70. Mean ankle dorsiflexion and plantar flexion were significantly lower on the affected sides (14.07 ± 7.97° and 36.30 ± 6.59°) than on the unaffected sides (28.15 ± 2.82° and 46.30 ± 2.97°), respectively (p < 0.001). No significant difference for inversion and eversion was observed. Twenty-four patients demonstrated radiographic signs of ankle osteoarthritis, and three remained without evidence of osteoarthritis. No significant difference was found among Takakura's stages in any of the variables. Conclusion The results illustrated that although post-traumatic osteoarthritis rate was high for ankle fracture-dislocation patients, surgical treatment achieved excellent functional results. Even if advanced stages of ankle arthritis according to Takakura's classification developed, patients had satisfactory clinical and functional results.

Open Ankle Dislocation Without Associated Malleolar Fracture: Case Report

Open pure tibiotalar dislocations are rarely recorded cases with superficial fibular nerve damage. Case presentation: The authors describe a case of open tibiotalar dislocation without a fracture and a deep deltoid ligament damage as a result of a bad fall. Six hours after the trauma, debridement, open reduction, and casting were done. Following a 4-week checkup, the results were positive and infection-free. Conclusion: Early reduction and appropriate wound care of an open tibiotalar dislocation with delayed repair of an associated deep deltoid ligament tear led to a successful outcome.

Case report: A rare case of pure tibio-talar dislocation without malleolar clamp fracture in a young athlete: Long-term functional results and recent reviews of the literature.

Introduction and importanceAnkle dislocation without fracture is an extremely rare injury, requires high-energy trauma, up to 1995, only 73 cases were reported in the literature and 154 cases up to 2017. It is therefore a post-traumatic ankle disease growing in parallel with the increase in road-traffic accidents requiring the study of incriminated factors such as hypoplasia of the medial malleolus.Case presentationThe authors report the case of a young patient, a football player, who presented with a pure, closed dislocation of his ankle following a road-traffic accident. Management consisted of immediate reduction, followed by immobilization in plaster for 1 month,Clinical discussionThe short, medium and long term clinical and radiological results are excellent with no evidence of ankle instability or osteoarthritis.ConclusionAnkle dislocation without associated fracture is an extremely rare injury. The posteromedial dislocation represents the most described variety in the literature. Early management, short-term immobilization, adapted and early rehabilitation seem to be associated with good long-term functional results.

Pure Ankle Dislocation Without Associated Fracture: A Series of Cases and Our Clinical Experience.

Pure ankle dislocation without associated fracture is extremely rare. The current study reports eight cases of this type of injury, aiming to add some new material to the published data and present our clinical experience. Six open and two closed posteromedial tibiotalar dislocations without associated fractures treated in our department from 2015 to 2019 were retrospectively analyzed. Emergent reduction was performed for all patients followed by an average of 6weeks of immobilization with external fixators in open cases and a short leg cast in closed cases. No patients underwent ligament or capsule repair except one case. The clinical data were recorded and analyzed. At a mean follow-up of 33months (range 13-61), the average AOFAS score was 91 (range 78-100) with five ankles rated as excellent and three rated as good. All of the eight patients returned to their prior daily life and the two closed patients with sports injuries resumed pre-injury activity level. The average range of motion (ROM) loss of the ankles was 9 degrees for plantarflexion and 3 degrees for dorsiflexion. Complications included superficial infection, moderate ankle stiffness, ankle degenerative change and residual numbness. None of the eight patients showed obvious ankle instability. Pure ankle dislocation without associated fracture is a rare injury. Emergent reduction, appropriate wound care in open injuries and proper joint stabilisation with a cast or external fixator provide good clinical results and could be the mainstay of treatment.

What are the Injures that Lead to Post-Traumatic Ankle Osteoarthritis? A Long-Term Retrospective Analysis of 533 Patients

Category:Ankle Arthritis; Ankle; TraumaIntroduction/Purpose:Ankle osteoarthritis (AO) is an incapacitating condition for patients and a substantial burden for medical assistance. It is well known that the vast majority of AO occurs as a sequela of previous trauma. However, it is currently unknown what types of injuries of the foot and ankle most commonly lead to end-stage arthritis. Therefore, the purpose of this study was to investigate the etiology of end-stage ankle osteoarthritis in all patients who underwent ankle fusion or replacement at a tertiary care center over 20 years. We hypothesized that the most common injury patterns would correspond to low-energy lesions.Methods:The electronic medical record was queried using current procedural terminology (CPT) codes for ankle fusion or ankle replacement to identify all patients who underwent either of these procedures at a single tertiary academic center over 20 years. Etiologies were broadly grouped as Pilon/Plafond fracture, ankle fracture, talus fracture, tibia fracture, single or recurrent sprains, infection/septic joint, systemic disorder (Charcot arthropathy, rheumatoid arthritis, hemophilic arthropathy), and idiopathic/primary osteoarthritis. Each fracture pattern was then subclassified using commonly accepted classification systems by two independent observers in addition to the grade of arthritis at the time of fusion or replacement. Reliability among readers was assessed by Kleiss kappa. Normative data were analyzed by ANOVA and comparison among groups and methods by Student's T- test.Results:A total of 533 patients were included in this study. The initial injury patterns were broadly classified as pilon/plafond (65), ankle (173), sprains (110), talus (17), tibia (22), tibiotalar dislocation without fracture (1). Other identified etiologies included rheumatoid arthritis (18), Charcot arthropathy (11), progressive collapsing foot deformity (21), septic arthritis (5), and cavovarus (6). The average time interval between the initial injury and definitive treatment for end-stage arthritis was 558 days. Ankle fractures classified as 44C1 (14,1%), 44B3 (10.6%), 44B2 (9.3%) followed by pilon 43C3 (6.5%) and 43C1 (4.1%) were the most prevalent subclassification found in the fractures group.Conclusion:The primary etiology for AO is secondary due to trauma. A history of ankle sprains and instability was found in 20.6%. Fractures corresponded to 54,6% of our cohort, ankle fractures producing most of these lesions. When considering the subtype of injury, ankle fractures with a 44C1 and a 44B3 classification were the more frequent presentation. These findings could support the argument that complex low-energy rotational traumas do not carry a benign course. Comprehension of the AO etiology scenario may guide prevention policies and specific primary treatment guidelines to diminish disease impact on the population and health care system.

What are the Injures that Lead to Post-Traumatic Ankle Osteoarthritis? A Long-Term Retrospective Analysis of 533 Patients

Category:Ankle; Ankle ArthritisIntroduction/Purpose:Ankle osteoarthritis (AO) is an incapacitating condition for patients and an important burden for medical assistance. It is well known that the vast majority of AO occurs as a sequela of previous trauma, however, it is currently unknown what types of injuries of the foot and ankle most commonly lead end-stage arthritis. The purpose of this study was to investigate the etiology of end-stage ankle osteoarthritis in all patients who underwent ankle fusion or replacement at a tertiary care center over a 20-year period. Our hypothesis was that the most common injury patterns would correspond to low-energy lesions.Methods:The electronic medical record was queried using current procedural terminology (CPT) codes for ankle fusion or ankle replacement to identify all patients who underwent either of these procedures at a single tertiary academic center over a 20-year period. Etiologies were broadly grouped as Pilon/Plafond fracture, ankle fracture, talus fracture, tibia fracture, single or recurrent sprains, infection/septic joint, systemic disorder (Charcot arthropathy, rheumatoid arthritis, hemophilic arthropathy) and idiopathic/primary osteoarthritis. Each fracture pattern was then subclassified using commonly accepted classification systems by two independent observers in addition to the grade of arthritis at time of fusion or replacement. Reliability among readers was assessed by Kleiss kappa. Normative data were analyzed by ANOVA and comparison among groups and methods by Student's T- test.Results:A total of 533 patients were included in this study. The initial injury patterns were broadly classified as: pilon/plafond (65), ankle (173), sprains (110), talus (17), tibia (22), tibio-talar dislocation without fracture (1). Other identified etiologies included rheumatoid arthritis (18), charcot arthropathy (11), progressive collapsing foot deformity (21), septic arthritis (5), and cavovarus (6). The average time interval between the initial injury and definitive treatment for end-stage arthritis was 558 days. Ankle fractures classified as 44C1 (14,1%), 44B3 (10.6%), 44B2 (9.3%) followed by pilon 43C3 (6.5%) and 43C1 (4.1%) were the most prevalent subclassification found in the fractures group.Conclusion:The main etiology for AO is secondary, due to trauma. History of ankle sprains and instability was found in 20.6%. Fractures corresponded to 54,6% of our cohort, ankle fractures producing most of these lesions. When considering the subtype of injury, ankle fractures with a 44C1 and a 44B3 classification were the more frequent presentation. These findings could support the argument that complex low-energy rotational traumas do not carry a benign course. Comprehension of the AO etiology scenario may guide prevention policies and specific primary treatment guidelines with the objective of diminishing disease impact on population and health care system.

Open posteromedial dislocation of ankle without associated fractures

&lt;p class="abstract"&gt;Dislocation of ankle without associated malleoli or talar fractures is a rare presentation. There is no established standard treatment for this condition. Most of them are treated by immediate reduction followed by immobilisation for 6-9 weeks. Majority of them recover without any complications. Here we reported a case of 33 year old man who was injured due to fall from a height, His ankle was deformed with a laceration over lateral side of ankle. Plain radiograph revealed posteromedial tibiotalar dislocation without any associated fractures. Immediate reduction and suturing was performed. At 5 months postoperative review patient was able to perform his daily routine without any instability or complaints.&lt;/p&gt;

Tibial Nerve Dysfunction Associated With Operatively Treated Talar Neck Fractures.

To investigate the presence of tibial nerve dysfunction (TND) in operatively treated talar neck fractures. Retrospective chart review. Urban Level-1 trauma center. Sixty-four patients for a total of 65 talar neck fractures treated with open reduction and internal fixation between January 1, 2014, and May 1, 2018. Incidence of TND. Evidence of TND was documented in 20 of 65 cases (30.8%) of talar neck fractures. There were no cases of TND associated with Hawkins I fractures, but TND was found in 7 of 32 Hawkins II fractures (21.9%), 10 of 24 Hawkins III fractures (41.7%), and 3 of 5 Hawkins IV fractures (60%). TND was reported in 11 of 19 open talar neck fractures (57.9%) (P = 0.002). TND was associated with tibiotalar dislocation (P = 0.017) but not subtalar dislocation (P = 0.17). TND did not occur in the absence of subtalar subluxation/dislocation. Of 18, a total of 6 (33.3%) reported partial recovery, and 6 (33.3%) reported full recovery within 6 months of the initial injury. By 12 months, of the 18, 8 (44.4%) reported partial recovery and 7 (38.9%) reported full recovery. The tibial nerve and its distal branches are at risk of injury in the setting of displaced talar neck fracture, tibiotalar subluxation/dislocation, and open talar neck fracture with increasing risk among those with a higher Hawkins grade. Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Tibio-Talar Dislocation: A Brief Review of Literature

Tibiotalar dislocation without concomitant fracture in the surrounding bones is a rare injury. Fahey and Murphy classified this lesion into 5 subtypes based on direction: posterior, anterior, lateral or superior combined. Only 4 cases have been reported in literature. Here, I document a brief review of literature. In this review, there are not figures and outcomes.

Treatment of open ankle dislocation without associated fractures in a young athlete using external fixation and ligament repair with suture tape augmentation

BackgroundAnkle dislocation without fracture is an extremely rare injury because it is usually accompanied by concomitant malleolar fractures from the anatomical and mechanical viewpoints.Case presentationWe report the case of a 17-year-old woman who was injured while playing basketball. Her ankle was swollen and deformed. Plain X-ray revealed tibiotalar dislocation in the medial direction without any fractures.Immediate reduction and ligament repair using suture tape augmentation were performed.ConclusionsAt 5 months postoperatively, the patient returned to playing basketball without any complaints. After an additional 2 months, the patient participated and played in the Winter Cup 2019 (the national high school basketball tournament in Japan) at the previous performance level.

Lussazioni pure di caviglia

Pure ankle dislocation is a rare event in Orthopaedic and Traumatology Emergency Departments. As it constitutes an emergency, prompt reduction is mandatory to reduce the risk of neurovascular impairment. In most cases, high energy trauma (motor vehicle or sports accident) is the cause of pure tibiotalar dislocation, as it leads to forced plantarflexion and inversion or eversion of the foot; young men are more often involved and predisposing anatomical factors as well as ligamentous laxity could favour dislocation. The following article provides a critical review of the current literature in order to outline the epidemiology, treatment, outcome and possible complications of pure ankle dislocation.

Tibiotalar dislocation without associated fractures

A luxação tibiotalar isolada é uma lesão incomum, frequentemente associada a fraturas e relacionada a acidentes de alta energia. Relatamos um caso de um paciente de 24 anos, do sexo masculino, que sofreu um trauma axial resultando em uma luxação pura tibiotalar posterior fechada. O tratamento foi realizado com redução incruenta, imobilização e acompanhamento ambulatorial. Quatro meses após a lesão, o paciente não relatava dor, tinha arco de movimento satisfatório, sem instabilidade residual ou início de osteoartrite pós-traumática. O mecanismo do trauma, o tratamento imediato, a importância da redução fechada e estável e a mobilização precoce são discutidos neste caso. Nível de Evidência V; Opinião de Especialista.

Distal tibiofibular synostosis after surgically resolved ankle fractures: An epidemiological, clinical and morphological evaluation of a patient sample

IntroductionAnkle fractures comprise a highly morphologically and etiologically diverse group of injuries, which includes various degrees of impairment of bone and ligamentous structures. The complete synostosis and incomplete bony bridging of tibiofibular syndesmosis are among the local late complications after surgically treated ankle fractures. Patients and method269 patients were evaluated, including 203 patients with Weber type-B fractures, and 66 patients with Weber type-C fractures. All patients underwent ankle radiography at standard intervals (post-operatively, 6 and 12 weeks, 6 and 12 months). The final assessment one year after osteosynthesis was performed. The study analyzed age, sex, fracture morphology, the location and morphology of ossification, functional outcomes and subjective evaluations of patient status. ResultsAs risk factors there were found male sex, tibiotalar dislocation, syndesmotic screw fixation and Weber type-C fractures. The severity of subjective difficulties and objective status were not dependent on the size of distal tibiofibular synostosis. Discussion and conclusionDespite relatively extensive imaging findings of complete synostosis or incomplete bony bridging, they only limited functional outcomes to a minimal extent.

Predictors of Time to Clinical Union in Ankle Fractures

Category: Ankle Introduction/Purpose: Ankle fractures are an increasingly common musculoskeletal injury and represent a substantial source of societal economic loss due to missed days of work and utilization of healthcare resources. While common protocols exist for postoperative management of these fractures, predictors of time to union have not been analyzed. We aim to evaluate patient characteristics, injury features and perioperative factors that predict time to union and may allow for optimized postoperative protocols and improved patient counseling. Methods: A cohort of consecutive patients with isolated, closed operative ankle fractures treated by multiple surgeons at a tertiary care academic medical center from 2008-2012 was retrospectively reviewed for time to clinical union. Clinical union was defined as plain film radiographic evidence of bony healing and minimal to no pain clinically. Patients with pilon fractures, open injuries, additional fractures and incomplete outcomes data were excluded from analysis. Means and standard deviations were calculated and multivariate linear regression modeling was utilized to identify predictors of time to clinical union. Results: A total of 108 isolated, closed operative ankle fractures met inclusion criteria. Of these, 99.1% achieved clinical union in less than 6 months and the remaining one patient completed union in a delayed fashion with the use of non-operative adjuncts. Mean time to union was 14.1 weeks (SD 5.3 weeks). Statistically significant negative predictors of time to union were BMI, dislocation of the tibiotalar joint, external fixation for initial stabilization and delay of definitive management (all p &lt; 0.05). Sex, age, diabetes mellitus, tobacco usage and high-energy mechanism were not significant after adjustment (Table 1). Fracture pattern and definitive operative fixation technique did not contribute to a parsimonious regression model and were excluded from final analysis. Conclusion: Time to clinical union after ankle fracture is significantly correlated with BMI, tibiotalar dislocation, external fixation for initial stabilization and delay of definitive management. In these instances, it is important to counsel patients about the potential for nonunion and consideration should be given to healing adjuncts such as prolonged non-weightbearing immobilization, bone stimulation and vitamin D.

Open Posteromedial Dislocation of the Tibiotalar Joint without Associated Malleolar Fracture: A Case Report

Background: Open pure tibiotalar dislocations with an associated superficial fibular nerve injury are rarely reported. Case presentation: The authors report a case of open tibiotalar dislocation without any associated fracture and an associated injury of superficial fibular nerve after a motorcycle accident. A debridement plus an open reduction and casting were performed sixteen hours after the trauma. After twenty-six months, the outcome was good without any infection and a sensitivity recovery of the foot. Conclusion: A delayed management of an open tibiotalar dislocation with an associated superficial fibular nerve injury led to a good mid-term outcome.

Classifications in Brief: The Hawkins Classification for Talus Fractures.

As reported by Coltart [5], Fabricius von Hilden first described talus injuries in 1608, and in 1919, Anderson et al. [1] reported a series of talus fracture dislocations in which they emphasized dorsiflexion as the mechanism of injury and coined the term ‘‘aviator’s astragalus’’ (astragalus being another term for talus) because of the impressive frequency with which the mechanism—aircraft accidents— was associated with the injury in question. In 1952, Coltart [5] reported on 228 talus injuries treated by surgeons in the British Royal Air Force in an attempt to describe the variety of injuries that occur to the talus and surrounding joints. He described various talus fracture patterns, fracture-dislocation combinations, and isolated peritalar dislocations [5]. Others have presented case series of talus injuries and associated rarely used classification schemes [15, 19], but all have noted high complication rates with injuries to the talus [5, 11, 15, 19]. In 1970, proposed treatment strategies for vertical fractures of the talar neck ranged from nonoperative management to urgent open reduction internal fixation, bone graft augmentation, fusion of the dorsal talus to the distal tibia, and even complete talectomy [11]. Although the importance of early, anatomic reduction of these injuries was noted at that time, the incidence of avascular necrosis (AVN) was not. In 1970 Hawkins [11] described injury patterns and AVN rates in a series of 57 vertical talar neck fractures in 55 patients from three different institutions. All 55 patients sustained forced dorsiflexion injuries, similar to the mechanism described by Anderson et al. [1] in pilots.

Unusual Orthopaedic Injuries from the World's Most Popular Sport.

When it comes to numbers of participants and spectators, there’s little doubt that soccer is the world’s most popular sport. It makes sense, then, that soccer sees its share of musculoskeletal injuries. The majority of soccer injuries affect the feet and legs, with sprains, strains, and ligament injuries of the knees and ankles being the most common. This month’s “Case Connections” focuses on the diagnosis and treatment of four not-so-common soccer injuries. In the December 10, 2014, JBJS Case Connector, Huri et al. present the case of a teenage professional soccer player with a chronic rupture of the rectus femoris muscle. The initial injury had occurred two years earlier when he kicked another player’s foot instead of the ball. Nonoperative approaches had not facilitated a return to running or kicking. At the time of presentation, doctors noted a prominence on the right thigh that was suggestive of a proximal rupture and distal displacement of the rectus femoris muscle. At an isokinetic speed of 240°/sec, the knee extension strength difference between the injured and normal limbs was 40%; pain prevented the patient from being tested at other isokinetic speeds. MRI of the thigh revealed extensive soft-tissue edema and a complete avulsion of the reflected head of the rectus femoris. Figure 1 shows the rupture location preoperatively and intraoperatively. Fig. 1 Arrows indicate the location of the rectus femoris rupture preoperatively (top) and intraoperatively (bottom). Intraoperatively, surgeons moved the muscle belly proximally as far as possible …

Luxation talo-crurale pure chez un footballeur (À propos d’un cas et revue de la littérature)

Talocrural dislocation without associated fracture is a rare dislocation and is not commonly seen as a sport injury. The authors report the case of a football player who presented a tibiotalar dislocation. The treatment was orthopedic with a very good functional result. Immediate reduction was performed followed by eight weeks of cast immobilization. After 26 months of follow-up, functional results were satisfactory. We try through this case and a review of the literature to underline the rarity of this entity, its predisposing factors, and the difficulty its therapeutic coverage as well as the interest of the rehabilitation, which conditions the functional recovery of the ankle.

Osteonecrosis of distal tibia in open dislocation fractures of the ankle

IntroductionOpen ankle dislocation fractures are one of the most severe injuries of the ankle. Development of posttraumatic arthrosis is well known. However, there are just a few case reports describing evidence of posttraumatic osteonecrosis (PON) of distal tibia. The pathophysiological mechanism remains unclear and the question of morphologic or personal risk factors cannot be answered. The goal of this study was to evaluate the morphologic characteristics of open dislocated ankle fractures in correlation with the development of PON to facilitate early identification of patients with higher risk of posttraumatic osteonecrosis. Material and methodsIn this study data from 28 patients with open dislocation fractures of the ankle between 1975 and 2006 found at our databases were evaluated retrospectively. For each patient we documented personal data, mechanism of injury, type of lateral malleolar fracture, severity of open fracture, degree of tibiotalar dislocation, presence of medial malleolar fracture, presence of deltoid ligament rupture, time until joint reduction and kind of surgical treatment. We also documented clinical complications and number of surgeries. Presence of PON was examined by radiographs, magnetic resonance imaging (MRI) or histological analysis. ResultsWithin 12 out of 28 patients with open ankle dislocation fractures a PON of the distal tibia could be found. Nine out of 15 patients with high-energy trauma and 12 out of 19 patients with type C fibular fracture developed PON. 73% of male patients and 88% of the patients with type III soft tissue damage according to Gustillo developed PON. However, if patients suffered from type C fibular fracture, total talus dislocation and grade III soft tissue damage (“necrotic triad”) PON was developed in 100% of cases. Other patient's characteristics like late joint reduction, postoperative infection or bimalleolar fracture showed no higher proportion of patients with PON. ConclusionIn this study we were able to identify clinical manifestations and risk factors for the development of PON of the distal tibia. All indentified risk factors were associated with heavy fracture mechanisms leading most likely to a serious devascularisation of at least parts of the distal tibial epiphysis. With regard to presented results early identification of patients with higher risk of PON might be possible and maybe additional treatment options can be initialised to protect patients from this process.

A new look at the Hawkins classification for talar neck fractures: which features of injury and treatment are predictive of osteonecrosis?

Osteonecrosis and posttraumatic arthritis are common after talar neck fracture. We hypothesized that delay of definitive fixation would not increase the rate of osteonecrosis, but that the amount of initial fracture displacement, including subtalar and/or tibiotalar dislocations, would be predictive. We investigated the possibility of dividing the Hawkins type-II classification into subluxated (type-IIA) and dislocated (type-IIB) subtalar joint subtypes. The cases of eighty patients with eighty-one talar neck and/or body fractures who had a mean age of 36.7 years were reviewed. The fractures included two Hawkins type-I, forty-four type-II (twenty-one type-IIA and twenty-three type-IIB), thirty-two type-III, and three type-IV fractures. Open fractures occurred in twenty-four patients (30%). One deep infection, two nonunions, and two malunions occurred. After a mean of thirty months of follow-up, sixteen of sixty-five fractures developed osteonecrosis, but 44% of them revascularized without collapse. Osteonecrosis never occurred in fractures without subtalar dislocation (Hawkins type I and IIA), but 25% of Hawkins type-IIB patterns developed osteonecrosis (p = 0.03), and 41% of Hawkins type-III fractures developed osteonecrosis (p = 0.004). Osteonecrosis occurred after 30% of open fractures versus 21% of closed fractures (p = 0.55). Forty-six fractures were treated with urgent open reduction and internal fixation (ORIF) at a mean of 10.1 hours, primarily for open fractures or irreducible dislocations. With the numbers studied, the timing of reduction was not related to the development of osteonecrosis. Thirty-five patients had delayed ORIF (mean, 10.6 days), including ten with Hawkins type-IIB and ten with Hawkins type-III fractures initially reduced by closed methods, and one (5%) of the twenty developed osteonecrosis. Thirty-five patients (54%) developed posttraumatic arthritis, including 83% of those with an associated talar body fracture (p < 0.0001) and 59% of those with Hawkins type-III injuries (p < 0.01). Following talar neck fracture, osteonecrosis of the talar body is associated with the amount of the initial fracture displacement, and separating Hawkins type-II fractures into those without (type IIA) and those with (type-IIB) subtalar dislocation helps to predict the development of osteonecrosis as in this series. It never occurred when the subtalar joint was not dislocated. When it does develop, osteonecrosis often revascularizes without talar dome collapse. Delaying reduction and definitive internal fixation does not increase the risk of developing osteonecrosis.